Healthcare Provider Details

I. General information

NPI: 1104979335
Provider Name (Legal Business Name): NOELLE SUMMERS LARSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED NATIONAL MILITARY MEDICAL CENTER 8901 WISCONSIN AVE
BETHESDA MD
20889
US

IV. Provider business mailing address

WALTER REED NATIONAL MILITARY MEDICAL CENTER 8901 WISCONSIN AVE
BETHESDA MD
20889
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4959
  • Fax:
Mailing address:
  • Phone: 301-295-4959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number0101243053
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: